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General NPI Number Information
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NPI Number | 1497049043
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Entity Type | Organization
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Legal Business Name | TRIBAL EYES
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 160 FRANKLIN STREET SUITE 205
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City | OAKLAND
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State | CA
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Zip | 94607-3759
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Country | US
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Telephone | 510-268-8091
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Fax | 510-268-8093
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Provider Business Mailing Address
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Address Line | 6207 MAJESTIC AVE
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City | OAKLAND
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State | CA
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Zip | 94605-1860
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Country | US
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Telephone | 510-361-8879
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DANIEL STEPHEN COLEMAN
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Credential | CLD SLD RDO FNAO
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Telephone | 510-361-8879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | D7655
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License Number State | CA
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